Success of medical management of labial adhesions

Abstract

BACKGROUND: The treatment of labial adhesions with topical estrogen has been reported to have a success rate between 88% and 89%, with almost 50% of these requiring some form of manual separation in the office. The purpose of this study was to evaluate the management of labial adhesions at the Hospital for Sick Children in Toronto, Canada.METHODS: A retrospective chart review of all patients with labial adhesions at the pediatric and adolescent gynecology clinic from 1993 until November 2000.RESULTS: A total of 251 patients were diagnosed with labial adhesion. Of these 168 (67%) were primary diagnoses and 83 (33%) recurrent. The age ranged from four months to sixteen years. All patients without urinary obstruction were treated with topical estrogen cream (Premarin® by Wyeth or Ortho® Dienestrol) BID for two to six weeks. Patients were re-evaluated every two weeks; the cream was discontinued once separation occurred. A total of 23 (9%) had surgical/mechanical separations performed; 3 for urinary obstruction, 4 because of maternal demands, 3 had reactions to the cream, 13 were medical failures. Children over six years of age were more likely to require surgical intervention despite prolonged medical therapy (up to 10 weeks). Medical therapy effected separation in 228 (91%); the treatment period was 2 weeks 94 (38%), 4 weeks 111 (44%), 6 weeks 21 (8%). Limiting the application of estrogen cream solely to the labial join minimized systemic estrogen effects. In 1996 preventive measures were taught after separation and this appeared to reduce recurrences.CONCLUSION: Surgery is rarely necessary for the management of labial adhesions if topical estrogen cream is used appropriately. Complete separation may take up to six weeks so perseverance may be necessary to avoid the potential complications from a surgical procedure. The older the child the greater the incidence of dense adhesions and risk of medical failure. Preventive measures may decrease the recurrence rate.